Timely Endocrine Referral for Short Stature Children Born Small For Gestational Age

Approximately 10% of children born small for gestational age (SGA) fail to achieve catch-up growth by two years of age. These children will remain with short stature throughout life without effective medical intervention. Sound research exists demonstrating the optimal treatment initiation period to be between two and four years of age in this patient population. The literature demonstrates that in practice, the average age of growth hormone (GH) treatment initiation in qualifying children born SGA is 8.4 to 9.1 years of age. Initiation of GH treatment beyond the optimal initiation period is associated with decreased efficacy, increased cost, and increased duration of treatment. At the present time, there is a lack of specific clinical guidelines, directed to primary care providers, for timely endocrine referral for children with growth problems who also have a history of SGA. The purpose of this scholarly project was to create a clinical guideline for timely endocrine referral in this specific patient population and to make this guideline accessible to primary care providers throughout the state of Utah. The ACE Star Model of the Cycle of Knowledge Transformation provided the theoretical framework through each phase of this project. This project was accomplished through the creation of an evidence based clinical guideline that was guided by content experts and supported by the most recent research findings. The clinical guideline was evaluated using a 37 item appraisal instrument. This project was considered complete with the creation of the clinical guideline, submission of the guideline to the Medical Home Portal Project for dissemination, and the creation of a poster to be presented at the Utah Nurse Practitioner Pharmacology Conference 2013. The doctorate of nursing practice (DNP) essentials met by this project include: Essential I, scientific underpinnings for practice; Essential II, organizational and systems leadership for quality improvement and systems thinking; Essential III, clinical scholarship and analytical methods for evidence-based practice; Essential V, health care policy for advocacy in health care; Essential VI, interprofessional collaboration for improving patient and population health outcomes; Essential VII, clinical prevention and population health for improving the nation's health; and Essential VIII, advanced nursing practice. These essentials were met through a thorough review of the literature and the creation and dissemination of a clinical practice guideline.